Wednesday, January 14, 2009

Human organ trade - fait accompli? Why am I not surprised....?

So the Ministry of Health has floated another balloon about the human organ trade issue. This time it declared it has completed a 1 month long exercise (1 month!! whoohoo...! That was a long and comprehensive exercise!) to get public opinion on the proposed amendments to HOTA (Human Organ Transplant Act).

Apparently 86 % had favoured some sort of reimbursement (fair 'nuff) and a majority suggested appropriate sums of at least S$50,000. How this figure was arrived at, we do not know. The Press Release tells us that there were 55 respondents (wow!), 9 written submissions from various oprganizations (we are not told which organizations so we can't say if these were biased opinions..!) and 162 participants surveyed at the People's Association dialogue session.

Well, I seriously question the validity of such feedback...and doubt the representativeness of these opinions. It could well represent the first steps towards understanding the full range of public opinion, but currently these are very sparse numbers and likely to only represent interest groups.

Of particular concern for me has always been the issues pertaining to the 'reimbursements' for donors. I have nothing against this per se, and I think we should adequately compensate the donor. But reimbursements really open the way to unethical practices related to a] free market trading of human organs, and b] inducements/exploitation of the poor. The MOH has been deliberately vague about these issues preferring to defer the consideration until after the law has been amended. It says, "These are operational details which the Ministry will take into account after the law has been amended.". Ho hum. Isn't it clear that because these are sticking points in the deliberations, we do need to clarify these before we amend the law? Once the law has been amended we will all just be driven down the road by operational details which may not underpinned by ethical principles.

With regards to foreigners, the MOH says, "The law will have to apply equally to all donors and patients if the transplants take place in Singapore. Otherwise, there may be double standard. If the law is amended, MOH would issue guidelines to the Hospital Transplant Ethics Committees so that they can better judge between what is reasonable compensation and what is inducement."

What this means really is that if this is delegated downwards to the hospitals, the commercial interests of the hiospital will become paramount. Ethics Committees or no. The hospital ethics committees decide on how much to reimburse foreigners for organs...? Duhhh.... Imagine NUH and SGH bidding against each other for organs? This is somehow ethical?

Imagine every kidney failure in the world flocking to Singapore for their transplant (wooohoooo....big mega bucks business!), then imagine the major transplantation hospitals sending out recruitment teams to Indonesia, Bangladesh and Africa etc etc....sourcing for organs. ...

Can it ever be controlled?

I think MOH has to do a little bit more work to tell us specifically how they are going to manage this before I will go along with their scheme to turn us into the organ trading capital of the world. But the cynical me feels they die-die will push this through whether we like it or not, because it will bring in the patients for our MedicalHub.